ABSTRACT
INTRODUCTION: due to the fact that lung disease due to SARS COV 2 infection is of recent appearance and the lack of knowledge about its natural history, it is not clear the moment of adequate follow-up by diagnostic images, this being suggested after 3 months of the onset of the symptoms according to the evolution of the patient. We present the variation of image findings of a patient with severe COVID-19 pneumonia. DESCRIPTION:we present the case of a 56-year-old male patient who required initial hospitalization of 14 days because of symptoms secondary to multilobar severe pneumonia due to SARS-COV-2 infection with initial tomographic findings of classic pattern given by ground glass opacities of subpleural distribution predominantly in the lower lobes. The patient was discharged with low flow oxygen supplementation and attended the pulmonology consultation a month later reporting improvement in dyspnea with medical research council score grade 1 and complete withdrawal of oxygen support. A control chest computed tomography was taken 6 weeks since initial evaluation reporting subpleural bullae of recent appearance in the upper and lower right lobe with diameters of up to 80 mm. It was also described a small residual laminar pneumothorax adjacent to the lingula with pleural effusion with apparent septae. Given these findings, an intervention by thoracic surgery was requested who decided to schedule a surgical procedure and performed a new control image corresponding to 8 weeks from the initial one with findings of complete and spontaneous resolution of the pneumothorax as well as the pleural effusion although persistence of the bullas. It was decided there was not required further interventions and patient was discharged from follow-up.DISCUSSION: SARS-CoV2 infection manifests itself in different patterns of lung damage and can have long term pulmonary sequelae that are only identified with judicious and strict follow-up during the first months after infection. Nevertheless, the British Thoracic Society (BTS) has recommended the first image follow-up to be preformed after 3 months of the initial symptoms because of the high incidence of image alterations in that period of time and lesser probability of occult malignancy. This case described a rare presentation of lung damage with equally spontaneous resolution of the complications confirming the timeframe proposed by the BTS.
ABSTRACT
INTRODUCTION: residual lung injury in patients recovering from COVID-19 information is scarce. Herein, we present a previous confirmed SARS-CoV2 infection case series including five patients, who underwent either open or transbronchial lung biopsy due to no clinical improvement. DESCRIPTION: Case 1: a 73-year-old male patient initially asymptomatic, with positive RT-PCR after transurethral resection of the prostate. Consulted for dyspnea and room air desaturation after 24 days during postoperative. Chest computed tomography reported findings compatible with organizing pneumonia, then a transbronchial biopsy was performed confirming diagnosis. Case 2: a 48-year-old male patient with COVID-19 pneumonia who required 14 days hospitalization. He was readmitted after 25 days since initial symptoms due to dyspnea and room air desaturation with a chest CT that revealed findings suggestive of pulmonary fibrosis. Therefore, an open lung biopsy was performed with a probable usual interstitial pneumonia pattern report. Case 3: a 86-year-old male patient, with initial mild COVID-19 infection who later progressed to severe pneumonia requiring high levels of supplemental oxygen. At 18 days of admission, due to persistent clinical compromise, a chest CT was performed with findings of organizing pneumonia. Therefore, he was taken to transbronchial lung biopsy that revealed non-specific interstitial pneumonia in the fibrosing phase. Case 4: a 61-year-old male patient with HIV/AIDS infection presented acute respiratory distress syndrome due to severe COVID-19 pneumonia with inability to withdraw invasive mechanical ventilation after one month. An open lung biopsy was performed with histopathology diagnosis of diffuse alveolar damage in the proliferative phase.Case 5: 41-year-old male patient with severe COVID-19 pneumonia requiring invasive mechanical ventilation, with persistent use of high levels of supplemental oxygen after 30 days since symptomatic. The chest CT suggested pulmonary fibrosis;therefore, an open lung biopsy was performed and confirmed Non-Specific Interstitial Pneumonia. DISCUSSION: to date, reports of interstitial lung disease due to COVID-19 refer to imaging findings or post-mortem histopathological studies which have been relatively limited given the strict guidelines and restrictions for performing bronchoscopies and lung surgery during the pandemic. The foregoing highlights the importance of tissue analysis under rigorous safety protocols in order to provide an early detection of interstitial lung involvement secondary to SARS-CoV-2 infection and then evaluate a prolonged steroid treatment recommendation.